The Health Department has confirmed that 7,707 health workers and 4,288 people aged 60 years and older had received SMSes by 11pm last night for Covid-19 vaccination appointments on Monday. According to Nicholas Crisp, who is helping to manage the roll-out of Phase 1B for health workers, seven people who had received such messages had been vaccinated by 8.30am on Monday. 

Crisp says the people who received messages had been selected on the basis of who registered first on the government’s electronic vaccination data system (EVDS). “First in, first vaccinated,” is the general rule, he says. “If you registered early, we will select you first, but, of course, within the context of making the selection geographically representative.”

More SMSes will go out today and each day of the week for vaccination appointments, although people living in old age homes will be prioritised in most provinces (people in homes won’t receive SMSes for appointments, as teams will visit the institutions and register and vaccinate residents on-site). 

Will all healthcare workers be vaccinated this week? 

On Sunday night, Health Minister Zweli Mkhize said the remaining 700,000 healthcare workers in the country — so those who were among the 478,733 health workers covered by South Africa’s implementation study (the Sisonke trial) will get jabs this week. Pfizer, however, requires two jabs, generally three weeks apart, so all health workers who get vaccinated this week will have to return for their second shot. Mkhize said South Africa is still deciding how long after a first Pfizer jab will the second be given.    

Crisp says there will be local challenges at different sites with giving all healthcare workers their first shot this week. “Some will be stuck in theatre, some will miss their appointments or be on night duty, and some will be on maternity leave. So it’s possible that all workers won’t get vaccinated this week. But the reality is, if a healthcare worker doesn’t get vaccinated this week, they’ll get vaccinated next week,” he says.

Crisp says public healthcare workers are being prioritised by provincial health departments, after which workers at private healthcare facilities will be targeted by their employers, and those in private practice such as doctors and psychologists working from home will be managed through a separate appointment system. We will announce the arrangements soon.”

Crisp says South Africa has enough vaccinations to cover all healthcare workers within the next two weeks. According to Mkhize the country has received 975,780 Pfizer doses and another batch of 325,260 will arrive next Sunday. 

Are comorbidities in or out as a prioritisation category? 

Crisp confirmed that comorbidities are no longer used as a category to prioritise vaccinations. Rather, age is.  

Why? 

Research has shown that age is the strongest predictor of how likely someone is to end up in hospital or die of Covid-19. According to the US Centers for Disease Control more than 80% of Covid-19 deaths occur in people over 65, and more than 95% in people older than 45.

Because many Covid-related comorbidities such as diabetes are more likely to affect middle-aged and older people, a sizeable proportion of comorbidities would be covered if older people are vaccinated first.  

In South Africa, people older than 40 make up the bulk of people living with comorbidities (such as high blood pressure or diabetes), according to a South African Medical Research Council policy brief. 

Also, if the government prioritised people with underlying conditions such as high blood pressure or diabetes, people who are unaware that they have comorbidities wouldn’t be included, explained Lesley Bamford during an April presentation to union leaders. Bamford is the co-chair of the national vaccine coordinating committee. 

Crisp says comorbidities are also complex to verify on the EVDS system and age is therefore a considerably more reliable indicator to use for prioritisation. 

But he says that although the EVDS generally prioritises people on the basis of age, age within a cohort – for instance, age within the category of people of 60 and older – doesn’t play a role. “Those in a certain category, for instance, healthcare workers or people of 60 and older, who registered first, will get SMS messages for appointments first, not those who are the oldest.” 

What will happen to the unused doses from the Sisonke trial? 

The Sisonke trial, which ended on Saturday, received 500,000 Johnson & Johnson doses, of which 21,267 were not used. The  jabs will now be used for research by the South African Medical Research Council to test vaccines on specific groups of people, such as those with HIV, pregnant and lactating women and people with comorbidities. 

We can’t use the leftover Sisonke doses for Phase 1B (healthcare workers not covered by Sisonke) and Phase 2 (starting off with people of 60 and older) because the Sisonke doses were donated by J&J for research purposes and were registered in South Africa for use in a research setting. They can therefore not be used outside of a study environment.  

How do people register if they don’t have internet access? 

On Sunday night, provincial health representatives announced that teams are being sent out to villages, churches, shopping malls and South African Social Security Agency payout points to help people to register. Provincial health departments are also working with traditional healers to get people registered. In addition to this, the government has launched a USSD service that can be used with an analog phone and doesn’t require phone or data credit to use: 

Dial *134*832* and your ID number or *134*832# if you don’t have an ID number to register.

Alternatively, WhatsApp the word “Register” to 0600 123 456 and follow the instructions.

By Sunday, about 2.1 million people in South Africa – 914,000 out of 1.2 million healthcare workers and 1.227 million out of five million people older than 60 – had registered on the EVDS system. DM/MC

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.